NPI | 1164100558 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MO 2025010618) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WA LH61587925) |
101YP2500X Counselor, Professional (Licence: MO 2023022520) | |
Enumeration Date | 2023-07-06 |
Last Update Date | 2025-07-01 |